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#NatCon14

Facility Planning

Rethinking Flow in an Integrated Setting

Jeffrey Howard, CPA Chief Financial Officer

Cherokee Health Systems

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Integrated Care

Integrated Care is the process and product of

medical and mental health professionals

working collaboratively and coherently

toward optimizing patient health through

biopsychosocial modes of prevention and

intervention.

O’Donohue, Byrd, Cummings, and Henderson (2004)

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Cherokee’s Blended Behavioral Health and Primary Care Clinical Model

• Embedded Behavioral Health Consultant on the Primary Care Team

Real time behavioral and psychiatric consultation

available to PCP

Focused behavioral intervention in primary care

Behavioral medicine scope of practice

Encourage patient responsibility for healthful living

A behaviorally enhanced Healthcare Home

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Typical BHC Services in Primary Care

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Conjoint Consultation On-Demand Medication Consultation Care Management

Psychiatric Consultation

PCP Consultation

School/Agency Consultation

Prevention

Telephone Consultation

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Triage/Liaison Behavioral Health Consultation

Behavioral Health Follow-Up

Adherence Enhancement

Relapse Prevention

Behavioral Medicine

Consultative Co-Management

Group-based interventions

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If Buildings Could Speak… 5th Street Confessions

Jeff Howard, CPA Cherokee Health Systems

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5th 815 W North Street

Morristown, Tennessee

• Community Mental Health Outpatient Mental Health

Case Management

Day Treatment (Basement)

Center

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High Concentration of Persons with

Original Corporate Headquarters

SPMI

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6 Weeks Before Integration

Group Room

Office Office Office Office Office Office

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Integration (Phase 1)

Office Office Office Office Office

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Office Office Office Office Office

Integration (Phase 2)

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Integration (Phase 3)

Office

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Phase 4

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Phase 4

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Phase ?

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Other Examples

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Where do we go from here?

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#NatCon14

Designing Your Space for Integrated Care

Paul Tegenfeldt, MSW VP of Healthcare Integration

Navos Seattle,

Washington

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Overview

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SMI population’s life expectancy is 25 years less than the general population

4 year SAMHSA/PBHCI demonstration grant (2011-2015)

Navos is 1of 100 grantees across the country and 1 of 3 here in Washington State

Our goal is to develop a model that produces positive outcomes and is

financially sustainable

Partnership model with Public Health—Seattle

& King County as our primary care partner

Developing a health home for the SMI

population served at Navos

One stop shopping

Patient-Centered Health Home

Collaborative Care Model

Wellness Program

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#NatCon14

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Our Model

• Partnership with an FQHC having a

shared mission and experience

with a similar population

• Staffing Nurse Care Manager

Family Practice Physician and

Nurse Practitioner

Medical Assistants

Reception and referral staff • Full scope primary care services

operating as part of a

collaborative care team with

behavioral health clinicians

On-site lab and pharmacy

• Wellness Program Smoking Cessation

Exercise

Nutrition

• On-site primary care operating 4 days per week

#NatCon14

•

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Co-Location Collaborative Care

Co-Location

One stop shopping

Separate care teams

Separate health records

Separate treatment plans

Opportunity for informal curb

side consultation

Improved (but still limited)

communication between primary

care and behavioral health

providers

Improved referral arrangements

between primary care and

behavioral health providers

Collaborative Care

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One stop shopping

One care team One

health record One

treatment plan

Population focused care

coordination and

management using a patient

registry and ‘Treat to Target’

to manage treatment

Seamless referrals and

transfer of clients between

behavioral health and primary

care

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#NatCon14

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Navos Mental Health and Wellness

Seattle, Washington

#NatCon14

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Shared Reception

#NatCon14

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Exam Room

#NatCon14

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Team Work Stations

#NatCon14

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Collaborative Work Area

#NatCon14

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3rd Floor

#NatCon14

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#NatCon14

Designing Your Space for Integrated Care

Case Studies in the Future of Integration

Timothy M. Rommel, AIA, MRAIC Principal

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The Outpatient Clinic: Modularity

Exam / Office as “Building Block”: 100 – 150sf

Half Module

2x Module

Full Module

1.5x Module

Exam Office/ Consult

Conference Clean Supply

Hskp. Treatment

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The Outpatient Clinic: Organization

OFF OFF OFF OFF OFF STAFF Key Drivers: •

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Flow / Access Flexibility

Standardization / Modularity

Clarity of Circulation

EXAM CONFERENCE EXAM SPT SPT

EXAM EXAM TREATMENT

EXAM EXAM EXAM EXAM NURSE

RECEPTION EXAM EXAM EXAM EXAM

Patient / Public Arrival Internal Patient Flow

Internal Staff Flow WAITING

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The Outpatient Clinic: Flexibilty

8 Ph4ysPi6chiPyashniyscsi2aicnPiashnyssicians OFF OFF OFF OFF OFF STAFF OFF OFF OFF OFF OFF STAFF OFF OFF OFF OFF OFF STAFF

EXAM CONFERENCE EXAM EXAM CONFERENCE EXAM EXAM CONFERENCE EXAM SPT SPT SPT SPT SPT SPT

EXAM EXAM EXAM EXAM EXAM EXAM TREATMENT TREATMENT TREATMENT

EXAM EXAM EXAM EXAM EXAM EXAM EXAM EXAM EXAM EXAM EXAM EXAM NURSE NURSE NURSE

RECEPTION RECEPTION RECEPTION EXAM EXAM EXAM EXAM EXAM EXAM EXAM EXAM EXAM EXAM EXAM EXAM

WAITING WAITING WAITING

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Juravinski Centre for Integrated Healthcare | Hamilton, ON

Lake Huron

Catchment Area

Principal Mental Health Services

Toronto Lake

Ontario

Extended Forensic Services

Hamilton

Buffalo

Lake Erie Medical Services

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Juravinski Centre for Integrated Healthcare | Hamilton, ON

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Juravinski Centre for Integrated Healthcare | Hamilton, ON

Outpatient Medical/Imaging Outpatient Psychiatric

Auditorium / Public Inpatient Psychiatric

Secure Inpatient Access Public Access

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Juravinski Centre for Integrated Healthcare | Hamilton, ON

Secure Inpatient Access Public Access

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Juravinski Centre for Integrated Healthcare | Hamilton, ON

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Juravinski Centre for Integrated Healthcare | Hamilton, ON

Outpatient Zone •

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Patient Access Staff Work Areas

Research Connectivity

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Juravinski Centre for Integrated Healthcare | Hamilton, ON

Typical Clinic •

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Flow / Access Flexibility

Standardization

Clarity of Circulation

Staff Work Area Group Rooms

Clinic Flexibility

Waiting / Reception Clinics 1, 2, 3, 4

Support / Procedure

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Centre for Addiction and Mental Health | Toronto, ON

Urban Integration

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Centre for Addiction and Mental Health | Toronto, ON